If your child or a child you know has been diagnosed with a Congenital Diaphragmatic Hernia, known as CDH, you are probably a little scared. Any diagnosing involving a child that you care about can be nerve racking, especially when it is something that can be pretty serious. After having been personally affected by what a congenital diaphragmatic hernia can do, I put what you need to know about it right here.
What is it?
Once you have heard the term, you will need to know what it actually means. A congenital diaphragmatic hernia happens with the diaphragm is not formed correctly during development. The result is that the abdominal organs are pushed upward into the chest cavity, which can put pressure on the lungs and cause them to not fully develop like they are supposed to.
There are two major complications that happen with CDH that can be troublesome: pulmonary hypoplasia and pulmonary hypertension. There is no consensus as to what is more serious between the two, but the bottom line is that neither should be brushed off as no big deal. Pulmonary hypertension is where the blood flow is restricted through the lungs because of how the lungs were formed. Pulmonary hypoplasia is where the lungs are not developed all the way, making it impossible to take a complete breath.
When is it diagnosed?
CDH can be diagnosed before birth during the anatomy ultrasound. In some cases, they can actually perform a fetal intervention, which is to prevent respiratory distress after the baby is born. If it isn’t seen in an ultrasound before the baby is born, there is usually respiratory failure when the baby is born. There are rare instances where the condition is not developed until adulthood or later in life because there was no imminent respiratory distress.
What is the prognosis?
While the prognosis for CDH in the past has been bleak, it has dramatically improved with the advancements of neonatal care and infant medicine in general. With appropriate treatment, CDH can be treated.
The hole in the diaphragm is usually repaired through surgery where the baby will be placed on a ventilator to help her breathe until her lungs begin working. They will usually do what is called a plication of the diaphragm which is usually performed thoracoscopically. Plication means that they will fold the eventrated diaphragm and suture it together so that the hole is closed properly. Once it is repaired and the surgery area has healed, the prognosis is good. To be honest through, there is about a 40% mortality rate for CDH, but it is getting lower and lower as research and treatment improves.
What are the different types?
There are three types of CDH:
- Bochdalek hernia: This is the most common kind of CDH and accounts for about 95% of all cases of CDH. There is a hole in the postero-lateral corner of the diaphragm so the abdominal viscera makes its way into the chest cavity. They are usually on the left side of the diaphragm.
- Morgagni hernia: This type of CDH accounts for about 2% of patients with CDH. There is a herniation through the foramina of Magagni and is right next to the xiphoid process of the sternum.
- Diaphragm eventration: This type is where there is an unusual displacement of the diaphragm into the chest cavity. Some of all of the diaphragm may have relocated. This is the rarest form of CDH. Because of the displacement of the diaphragm, the diaphragm is thinner which makes it more prone to having a hernia break through.